Pediatric hypertension: 2017 guidelines good at predicting adult risks

  • Hypertension

  • International Clinical Digest
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Takeaway

  • In comparing children classified as hypertensive under the 2017 guidelines update to the 2004 definitions, the 2017 guidelines capture children who have increased risk for adult disease.
  • This long-term study finds better sensitivity in the 2017 classifications for those at risk for later adult metabolic syndrome, hypertension, and left ventricular hypertrophy (LVH).

Why this matters

  • Accurately identifying children at higher risk can open the way to early lifestyle interventions to reduce that risk.

Key results

  • 2017 guidelines classified more children as having stage I or II hypertension vs 2004 version that categorized them as having prehypertension.
  • Proportions of children captured by the 2004 vs 2017 guidelines who later went on to develop specific conditions were higher (e.g., 12% vs 19% for LVH).
  • ORs (95% CIs) were higher with hypertension diagnosed by 2017 vs 2004 guidelines:
    • Adult hypertension: 2.37 (1.67-3.35);
    • Metabolic syndrome: 1.50 (1.07-2.31); and
    • LVH: 2.18 (1.23-3.88).

Study design

  • Longitudinal, multicenter Bogalusa Heart Study, Louisiana. 
  • 3940 children (age, 3-18 years; 47% boys); 36-year follow-up from childhood.
  • Funding: NIH.

Limitations

  • Community-based sample, and generalizability is not clear.